Learn what is Medical Billing and Coding, What are Medical Billing main responsibility and benefits to the doctor as well as patients.

Medical Billing and Coding is an essential part of the modern healthcare system, responsible for transforming patient diagnosis and procedures into alphanumeric and numeric codes. The transformation of the procedures into codes requires some level of training to accurate and effectively document the patient procedures and diagnosis with proper Medical Coding, in order to claim payments from Health Insurance.

What is Medical Billing and Coding?

When patient go to the doctor, there is a lot that happens behind the scenes that will eventually lead to the doctor getting paid. If patient is paying directly without any insurance being involved, getting payment is a very easy for doctor. However, with the involvement of single or multiple insurance, like i most cases in United States, the payment process gets complicated for the doctor.

This is where understanding what is medical billing and coding comes in. Basically medical billing and coding is the process of submitting claims to insurance companies and then waiting for a response from these companies. If they don’t respond, the person who submitted the claim needs to contact the insurance company for a follow up. Which is usually done by a Medical Billing and Coding specialist, simply called Medical Biller.

Medical Billing and Coding main Responsibilities

Medical billing and coding as a study field is an essential field for those people who do not want to spend lots of time in school but want to earn a sizable amount of income. Medical coders ensure correct classification of patient diagnosis and procedures into codes that can be used by insurance companies for the billing purposes. The most important codes used in medical coding are CPT codes and ICD codes.

CPT Codes or Current procedural or Terminology is used for the recording of all the visits that a patient makes to a health facility up to brain surgery. International Classification of disease codes ICD on the other hand are used to identify the problems for which the patients were diagnosed. For insurance claim forms medical coders are usually required to use a combination of both CPT and ICD codes to make claims.

Ones a patient visits a medical facility, history is recorded classifying all the diagnosis and procedures performed. After all this is performed medical coders begin their operation by assigning numerical codes to each diagnosis and procedures and then use a relevant software to determine the amount of money a hospital or clinical ought to be reimbursed. As a medical coder one does not necessarily need to interact with patients as he or she only deals with the recorded procedures and diagnosis. This field requires people who are organized able to work through huge chunks of papers

Accuracy in the assigning of the numeric and alphanumeric codes is of utmost importance in this case. This is for the sole reason that thousands or millions of dollars can be involved with each transaction. It is also essential for medical coders to abide by the ethics rules as patient medical records are usually private. Failure to do is always sure to guarantee prosecution. It is also vital for medical coders to ensure that all the medical codes meet the insurance legal and federal regulations to ensure for accurate payments.

Becoming a Medical Billing and Coding Specialist alternatively called Medical Biller or Medical Coder, requires a firm grasp of the various medical terminologies and the relevant codes that ought to be assigned to them. In combination, a prospective medical coder ought to posses the highest levels of computer skills able to peruse through huge chunks of data. Communication skills are also important in this case.

Medical Insurance Claims Submission

Claims are either submitted in paper form that are mailed or emailed through electronic forms or files that are sent to a clearinghouse over the internet. Medical Insurance Claims must be completed in compliance with insurance carrier’s guidelines.

Different companies have different requirements, so a specialist needs to know what is billing and coding procedure for each company to avoid payment denials for incomplete or improper information.

Along with personal information about the patient, claims also include up to six diagnostic codes that are relative to the most pertinent diagnosis that are being treated, and treatment codes that define what services the patient received. More than one date of service can be included on a single form.

Heath Insurance Payment Posting

Payments were generally received in postal mail in the form of a cheque or pay orders. Now days, insurance carriers has started to generate automatic electronic transfer deposits into practice accounts.

An explanation of benefits is sent under separate cover or can be viewed online, depending on what is medical billing and coding policy for the company. The explanation of benefits outlines what the cheque is specifically paying, including the patient’s name, date of service and service codes that have been paid.

Insurance companies pay a standard rate for each service that is agreed upon in the contract signed by the practice. Amounts charged above the agreed upon rates are written off, meaning the practice cannot charge the patient for the balance. Insurance payments are applied to the patient’s account, as are payments received directly from the patient. Statements are sent by the billing and coding specialist to collect balances due from the patients.

However, there are few difference between Medical biller and Medical coder in terms of a job position. Larger hospitals and clinics often employ billers and coders separately due to the volume of work accumulated on a daily basis. Small establishments and individual doctors’ offices usually will have one person doing both tasks simultaneously.

Medical coders use classified Medical Billing Softwares to assign the relevant numeric and alphanumeric codes to the relevant procedures and diagnosis that patients undergo in healthcare facilities. One of this software is DGR which is used by insurance company to determine the amount of money they need to reimburse to healthcare facilities for service rendered to their clients.

Professional medical coders can earn as low $46,000 in a year and are usually employed by hospitals, physician groups or private medical insurance companies. According to Salary.com and HR Data statistics, a Medical Biller Salary in NY can go around $32,236 to $56,000 annually. However, it is not a rosy job as severe penalties can be incurred or fined due to incorrect coding.

Medical Billing Coding Advantages

Medical professionals may use different terms for the same illnesses, medical coding is thus used to enable the standardization of this medical procedures and diagnosis.

Medical Billing Coding creates uniformity for procedures and services for proper reimbursement and reporting.Reimbursement is made easy and faster by the use of the medical codes which insurance companies are able to read and interpret easily for reimbursement purposes.

Medical Billing Benefits for Patients

Without Medical Billing Specialist, medical practices would not receive payments from insurance companies for services rendered. Instead, they would be forced to charge patients directly, who would in turn be responsible for trying to get reimbursement from the insurance carrier.

In other words, Medical Billing Specialist helps physician and patient in a way that both doctor and patient could focus less on insurance reimbursement worries and more on the healthcare and well being of patient.